■ Most patients assume anyone calling themselves MD has a medical license, but that's not true with some oral surgeons who are using the designation.

The Kansas Court of Appeals told Steven Thomas, DDS, in September to stop using MD in his practice. The ruling upheld an earlier decision from the Kansas State Board of Healing Arts.

Dr. Thomas is one of several oral surgeons who have earned medical degrees, primarily from the University of Health Sciences Antigua, and who have included these academic degrees in their titles.

Four of the five board members of the American College of Oral & Maxillofacial Surgeons, of which Dr. Thomas is president-elect, use the MD title. None hold medical licenses.

Many licensed physicians believe that this practice misleads the public and raises concerns about patient safety.

Steven Pearlman, MD, a member of the American Academy of Otolaryngology -- Head and Neck Surgery and president of the American Academy of Facial Plastic and Reconstructive Surgery, said this is yet another example of oral surgeons seeking to work beyond their scope.

"This is parallel to what happened in California," where oral surgeons recently tried and failed to win authority to perform elective cosmetic surgery of the head and neck, Dr. Pearlman said.

"If you are hanging MD on your shingle and you're not licensed, that's wrong," he said. "That's absolutely misleading the public. If these oral surgeons want to do this, they should go through the same pathway as U.S. [medical] doctors."

Dr. Thomas would only respond to AMNews via e-mail. "I practiced oral and maxillofacial surgery for 13 years before graduating from medical school, and my practice has not changed as a result of the additional degree," he wrote. "Nor have I gained any 'competitive advantage' as a result of the degree. It simply expanded the extent of my knowledge and made me a better oral surgeon. I think patients have a right to that information, and the court should not prohibit me from sharing it."

He wrote that court documents gave the wrong impression of the degree he earned.

The court opinion states: "Thomas received this degree through an advanced standing program at UHSA where he spent eight weeks on campus in Antigua."

Dr. Thomas said he completed 18 months of clinical rotations in the United States under the supervision of board-certified physicians, interspersed with eight weeks of lectures in Antigua and countless hours of assignments off campus.

FSMB frowns on practice

Neither ACOMS or the American Assn. of Oral and Maxillofacial Surgeons keeps track of how many of their members use medical degrees but do not have medical licenses. The legality of this practice varies from state to state. But it is considered dubious by many in the medical profession.

James N. Thompson, MD, president and CEO of the Federation of State Medical Boards, said such a practice goes against FSMB licensing guidelines.

"For all intents and purposes, if you use MD or DO after your name, you should be qualified to practice medicine," Dr. Thompson said.

In Kansas, state law prohibits unlicensed doctors from using MD.

In the appellate court opinion, the judge states, "By using the MD designation when he holds himself out to the public, Thomas could mislead the public into believing that he is a licensed MD who is engaged in the treatment or diagnosis of ailments, disease or injuries of human beings."

Mark Stafford, general counsel for the Kansas medical board, said Dr. Thomas was not accused of practicing outside his scope.

"Our goal was simply to get him to stop," Stafford said. "We were not trying to penalize or stigmatize him."

Christina Collins, director of government affairs for the Kansas Medical Society, said the group concurred with the medical board's action.

American Medical Association Trustee Rebecca J. Patchin, MD, a California anesthesiologist, said using a degree from an unaccredited medical school further complicated the matter.

"It's confusing to the public when people use a degree from a medical school that's not accredited," she said. "If individuals want to hold themselves out as a physician and surgeon, they should ... hold an active license to practice medicine."

The school Dr. Thomas attended is not accredited by the Liaison Committee for Medical Education, which only accredits U.S. and Canadian medical schools.

Graduates from international medical schools can be licensed in the United States once certain criteria are met. But graduates from UHSA are not permitted to apply for medical licenses in at least two states, California and Indiana.

Steven Guttenberg, DDS, vice president of the ACOMS, also uses the MD designation. Like Dr. Thomas, he obtained his medical degree from UHSA and does not have a medical license.

"The real hubbub is that we don't want to be misleading the public," Dr. Guttenberg said. "If you have a dental license and a medical degree and are practicing oral surgery, that's not deceiving the public."

And he said such efforts shouldn't be diminished. "He spent two years to get that degree, and it does give one recognition," Dr. Guttenberg said. "It adds a little bit of prestige and says you have a little more than the next [oral surgeon]."

Dr. Guttenberg uses the MD designation in his practice in Washington, D.C. He said using DDS, MD, doesn't present a patient-safety issue.

"I don't know of a single instance where a member of the public has been injured by someone with a dental license and a medical degree," Dr. Guttenberg said.

But Briant Coleman, a spokesman for the District of Columbia Dept. of Health, said the use of MD without a medical license while delivering health care is not in compliance with District of Columbia Board of Medicine regulations.

ADDITIONAL INFORMATION

Who they are; what they do

Oral and maxillofacial surgeons, as a specialty within dentistry, perform reconstruction of the maxillofacial and craniofacial complex, including the mouth, face and jaws. They also diagnose and treat diseases related to this region. The American College of Surgeons' guidelines for optimal care require Level I and Level II hospital trauma centers to have oral and maxillofacial surgeons on call. Here's the education path for the specialty.

Four years of undergraduate college.

Four years of dental school.

Four to seven years of hospital-based residency concentrating on the head and neck region, where they train alongside medical residents in general surgery, anesthesia, plastic surgery and otolaryngology. Of the 101 oral surgical training programs, 44 offer dual degrees in dentistry and medicine.

Sources: The American Assn. of Oral and Maxillofacial Surgeons, the American Board of Oral and Maxillofacial Surgery